Recurrent respiratory papillomatosis is a rare, benign, viral airway tumor that is caused by the human papillomavirus. The most common way for patients to present is with laryngeal papillomas. Diagnosis includes laryngoscopy and biopsy. Treatment is excision.
Recurrent respiratory papillomatosis most often occurs in the larynx as laryngeal papillomas. Laryngeal papillomas can occur at any age but are most common at ages 1 to 4 years.
They may reappear after treatment, undergo malignant transformation, and/or occasionally spread to the trachea or lungs.
Symptoms and Signs of Recurrent Respiratory Papillomatosis
Symptoms of recurrent respiratory papillomatosis can include weak cry, hoarseness, and, in severe cases, airway obstruction.
Diagnosis of Recurrent Respiratory Papillomatosis
Laryngoscopy
Biopsy
The tumor is identified by laryngoscopy. Recurrent respiratory papillomatosis may be a solitary lesion or it may manifest as multiple lesions.
The diagnosis is confirmed by biopsy.
Treatment of Recurrent Respiratory Papillomatosis
Excision
Treatment of recurrent respiratory papillomatosis is by excision. Because tumors may recur in weeks or months, multiple procedures may be required and surveillance by laryngoscopy and bronchoscopy is necessary. Surgery may involve pulsed-dye laser therapy or photodynamic therapy (1).
Antiviral (eg, cidofovir) or anticancer (eg, bevacizumab) medications have been tried in severe cases (Antiviral (eg, cidofovir) or anticancer (eg, bevacizumab) medications have been tried in severe cases (2). Lesions may regress at puberty in some patients.
Treatment references
1. Donne AJ, Keltie K, Burn J, et al. Current Practice, Safety and Efficacy of Interventions for Recurrent Respiratory Papillomatosis: Evidence From a UK Registry. Clin Otolaryngol. 2025;50(2):271-279. doi:10.1111/coa.14245
2. Derkay CS, Bluher AE. Update on recurrent respiratory papillomatosis. Otolaryngol Clin North Am. 2016;52(4):669–679. doi:10.1016/j.otc.2019.03.011
Prevention of Recurrent Respiratory Papillomatosis
HPV vaccine offers hope of prevention, and vaccination against HPV types 6 and 11 is effective in reducing disease prevalence. Although efficacy in children has not yet been proved, efficacy in adults has been proved (1, 2).
Prevention references
1. Seedat RY, Dikkers FG. Global Epidemiology of HPV-Associated Recurrent Respiratory Papillomatosis and Effect of Vaccination. Future Virol. 2022;17(5):265–268. https://doi.org/10.2217/fvl-2021-0278
2. Smahelova J, Hamsikova E, Ludvikova V, et al. Outcomes After Human Papillomavirus Vaccination in Patients With Recurrent Respiratory Papillomatosis: A Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2022;148(7):654-661. doi:10.1001/jamaoto.2022.1190
